Verbal Orders, Do you take them?

[nilepoc]

In my Hospital, a 300 bed teaching facility that has a level one trauma center and 24 hour coverage by all specialties, our surgical ICU is not allowed to take verbal orders. This practice stems from the nurses not being able to trust the residents to own thier verbal orders, and to prevent the doctors from allowing nurses to practice medicine without a license.

We have had many incidents in the past where residents have retracted verbal orders on rounds, when confronted by an attending. This is very bad, because our nurses come out looking like fools, and face the very real possibility of having and action filed against their license. Like I said above, to protect ourselves, we no longer take verbal orders. How do you prevent similar situations from occuring in your institution? Also, what is your policy regarding verbal orders.

The interesting thing, is that my most experienced nurses, know which residents they can trust and therefore continue to take verbal orders from some doctors. They know that they can get them written in the AM before rounds. Now, some of my inexperienced staff is trying to do the same and they are now getting hung once in a while, because they do not know who will own their orders in the AM.

Our staff is very vocal, and are getting upset that we cannot take verbal orders, and the rest of our institution can. We need to address this issue, but I am at somewhat of a loss, in how to aproach it. If verbal orders come back like they were two years ago, we are going to have many nurses practicing without a license.

So how would you rectify this perceived problem?

[Dazedgiggle]

I take verbal orders often on my unit (cardiovascular surgical), I can't imagine getting along without them! I'd never imagined there would be a problem with a doc owning his/her verbal order, and it's sad to know this problem exists. I also work in a non-teaching hospital. The surgeons and the nurses have a good relationship with each other as do the physicians assistants, whom we deal with more often, and have NEVER seen a problem with an MD or a PA not owning their order. We also have many protocols we can follow in case of certain emergencies, which is also a big help, or the PA/MD will include parameters with many of their orders so we don't have to call them or chase them down for anything. But if this is a problem where you work, then I guess getting verification from a second nurse is necessary, just to cover yourself.

[grouchy]

Hi- while this isn't really pertinent to the docs disowning orders issue, I'm chiming in. Strangely enough at my hospital we are told that if we have to take a verbal order, to write it up as a telephone order. Why this matters, I don't know. We are supposed to get all verbal and telephone orders cosigned by the doc ASAP. We've been told that too many verbal and telephone orders = JCAHO deficiency. We have little "sign here" stickers to put on the order sheets to remind the docs. When the state came through recently, we were told to not use these stickers as it might draw the state's attention to the large number of unsigned orders! I thought it would show that at least we were trying.

[deespoohbear]

At our facility we have a stamp we are suppose to use that has a line for the doc's signature, date and time. I absolutely refuse to use it.!! :( These doctors have over 12 YEARS of post high school education. They are making decisions that deal with life and death everyday! For crying out loud, they should at least know where to sign their name!!! The docs know they are suppose to sign off their orders in a certain time frame. No one is stamping little lines for the nursing staff so they know where to sign. I am sick and tired of catering to the physicians. I am not a babysitter for physicians!!

[canoehead, BSN, RN]

I'm glad there is another rebel out there who resents reminding other professionals what they have to do. They have two hands and a brain- they can take care of their own paperwork.

We already transcribe, phone, enter, carry out, recheck, call back, and second guess- sometimes translate and mind read. I also detest when certain docs want their charts laid out their way- stickers here, labs here, do this even though I didn't order it, don't do that though....OMG get over yourselves:rolleyes: .

[deespoohbear]

Oh, good!! I am not the only one with an attitude!! :D I just so sick and tired of babysitting the docs, the lab, the pharmacy. If I wanted to be a babysitter, I would have opened a day care!! The administration just bows down to the docs and gives them whatever they want and damn the consequences. We have one doc who is notorious for keeping his patients WAY longer than necessary and ordering all kinds of stupid tests for them!! Our ultilization review nurse has actually been told by the administrator not to pester this doc about his LOS for his patients. We wouldn't want to offend him, now would we? And the hospital is wondering why they are not earning money? It is because we have to eat the costs of all the procedures and tests not covered by insurance and Medicare. Duh! Sometimes I think a third grader would have more common sense!! :confused:

[mtgirl63]

Yes, I take verbal orders all the time, most of the time over the phone. I work in a LTC facility so the doctors are only in house once a month for rounds. The rest of the communication takes place over the phone and usually via their nurse at their office. I always repeat the order back to make sure it is correct, and then document that it was a T.O. and put both the nurses name and the doctor's name. At our facility, this has never back fired and never been a problem. I think I would be looking at the resident's that are trying to "take back" their orders when confronted --- they shouldn't be getting away with that and allowing the nurse to take the blame and look like the fool. If I were a nurse there --- I'd be hollering about the resident's not standing by their orders alot louder than hollering about not being able to take the verbal orders anymore. If I were continually being burned like that, I think I'd be refusing to take the verbal order anyway!!